Lipoprotein-associated phospholipase A2 (Lp-PLA2) is hypothesized to play a causal role in the development of atherosclerosis and to contribute to atherosclerotic plaque instability. In a randomized, placebo-controlled trial that enrolled 13 026 patients who had experienced acute coronary syndrome in the past 30 days, O’Donoghue and colleagues found that darapladib—an inhibitor of Lp-PLA2 —added to optimal medical therapy did not reduced the risk of major coronary events during 2.5 years of follow-up.
Postpericardiotomy syndrome and postoperative atrial fibrillation and effusions are common complications of cardiac surgery. Preliminary data suggest that postoperative administration of colchicine may prevent these complications. To assess whether this potential benefit might be enhanced with earlier initiation of colchicine, Imazio and colleagues randomly assigned 360 patients scheduled for cardiac surgery to receive colchicine or placebo beginning between 48 and 72 hours before surgery and continued for 1 month after surgery. The authors report that compared with placebo, perioperative use of colchicine reduced the incidence of postpericardiotomy syndrome but not postoperative atrial fibrillation or effusions.
Reanalyses of data from randomized clinical trials (RCTs) may help assess the validity of reported trial results. In a search of MEDLINE from inception to March 2014, Ebrahim and colleagues identified 37 reanalyses of patient-level data from previously published RCTs, which addressed the same hypothesis as the original article. Among the authors’ findings were that few of the reanalyses were performed by investigators independent of the original research group, and 35% of reanalyses led to changes in interpretation about patients who should be treated. In an Editorial, Krumholz and Peterson discuss open access to clinical trial data to allow independent replication of study findings.
Sickle cell disease affects nearly 100 000 individuals in the United States, many of whom do not receive optimal treatment. Yawn and colleagues summarize a 2014 expert panel report on evidence-based management of sickle cell disease. The authors found a paucity of clinical trials that addressed the screening, management, and monitoring of individuals with sickle cell disease, which resulted in many recommendations being based on less than high-quality evidence. The authors present the expert panel recommendations (including ratings of the recommendation strength and evidence quality) relating to health maintenance and management of acute and chronic complications of sickle cell disease. Use of 2 disease-modifying therapies—oral hydroxyurea and blood transfusion—are discussed. In an Editorial, DeBaun discusses challenges in defining evidence-based management guidelines for sickle cell disease.
Author Video Interview and Continuing Medical Education
An article in JAMA Internal Medicine reported that atrial fibrillation is independently associated with an increased risk of incident myocardial infarction. In this From the JAMA Network article, Prystowsky and Fry discuss pathophysiologic factors that may contribute to the association and the evidence that warfarin therapy may be beneficial.
A 63-year-old man consulted his physician about occasional night sweats without fevers or weight loss and worsening weakness and fatigue for 2 months. Physical examination was unrevealing. A white blood cell count and peripheral smear showed increased white blood cells, with a lymphocytic predominance. What would you do next?
Highlights. JAMA. 2014;312(10):977-979. doi:10.1001/jama.2013.279711